Type 2 diabetes: An Epidemic

Report
ARE WE READY FOR THE DIABETES
TSUNAMI?
Dr Nancy Ngugi
Consultant Physician , Endocrinologist
Diabetes Mellitus
Diabetes is a chronic metabolic condition
characterized by hyperglycemia, that occurs
as a result of lack of insulin or insulin
sensitivity.
Types of Diabetes Mellitus (DM)
 Type
1 Diabetes
 Type
2 Diabetes
 Gestational Diabetes
 Impaired glucose tolerance (IGT) and
impaired fasting glucose (IFG)
Predisposing factors to type 2
DM
 Physical inactivity
 Obesity
 Unhealthy diet
 Increasing age
 Family history of diabetes
 Ethnicity
 Poor nutrition during pregnancy affecting the
developing child
Symptoms of Diabetes
Type 2 diabetes is often without symptoms in its early
stages. That’s the reason there are 50% of people with
Type 2 diabetes are unaware of their disease.
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feeling tired and weak
Polyuria, nocturia
recurrent infections
blurred vision
weight-loss
excessive hunger and thirst
symptoms of peripheral neuropathy
slow healing wounds
Diagnosis
 Diabetes:
-RBS >11.1 mmol/ l
-FBS > 7.0 mmol/l
-HbA1c >6.5%
 If the RBS is > 5.6 mmol/l and < 11.1 then do the
FBS or OGTT
 OGTT- 75 g CHO in 250mls of water
OGTT Interpretation
FBS (Mmol/l)
2 hrs post prandial
(mmol/l)
Normal
<6.1
<7.8
IFG
6.1-6.9
<7.8
IGT
<6.1
7.8-11.1
Diabetes
>7.0
>11.1
Diabetes: Complications
Macrovascular
Stroke
Microvascular
Diabetic eye disease
(retinopathy and cataracts)
Heart disease and
hypertension
2-4 X increased risk
Renal disease
Peripheral
vascular disease
Erectile Dysfunction
Peripheral Neuropathy
Foot problems
Meltzer et al. CMAJ 1998;20(Suppl 8):S1-S29.
Management
 The primary treatment for type 2 diabetes is
exercise and diet.
 The aim of pharmacological management is to
reduce the risks of complications from diabetes
through;
 Glycemic control:
 Insulins
 Oral agents
 BP control
 Cholesterol control
 Aspirin
 Smoking cessation
 Moderate alcohol intake
Prevention
 Screening for type 2 diabetes and people with
no symptoms is recommended for:
 Overweight children who have other risk factors for
diabetes, starting at age 10 and repeating every 2
years
 Overweight adults (BMI greater than 25) who have
other risk factors
 Adults over 45, repeated every 3 years
 Those with a history of gestational diabetes
 Maintain a healthy body weight and keep an
active lifestyle to help prevent type 2 diabetes.
Diabetes is an increasing
healthcare epidemic throughout
the world
Africa
52.6
64.0
+22%
37.7
51.2
+36%
Eastern Mediterranean
and Middle East
Europe
32.8
59.7
+83%
North America
South and Central America
South-East Asia
Western Pacific
IDF. Diabetes Atlas 5rd Edition – 2011
25.1
39.9
+59%
14.7
28.0
+90%
131.9
187.9
+42%
71.4
120.9
+69%
Worldwide:
366 million people in 2011
552 million projected for 2030
51% increase
12
Global situation
 Type 2 DM is increasing in every country
 80% of people with DM live in low and middle
income countries
 Most people with DM are between 40 to 59 years of
age
 183 million people (50%) with DM are undiagnosed
 DM caused 4.6 million deaths in 2011
 78,000 children develop type 1 diabetes every year
 280 million people with IGT in 2011, will increase to
398 million in 2030
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Situation in Kenya
 Prevalence of diabetes
 2.7% in rural areas
 10.7% in urban areas
 Prevalence of IGT/IFG
 8.8 % in rural areas
 14.4 % in urban areas
 53% of all hospital admissions are due to Non
Communicable Diseases of which 28% due to
Diabetes
 Increasing cases of childhood diabetes
 Increasing cases of gestational Diabetes
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Situation in KNH
Adult diabetic clinic attendance in 2011 (Jan- Dec)
new pts
revisits
Main clinic (Fri)
448
2530
Mini clinic ( Mon-Fri)
153
5190
Pead diabetic/ endo
(Tue clinic)
178
683
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What are we doing as the diabetes
fraternity in Kenya?
 Kenya national diabetes strategy 2010-2015
 National clinical guidelines for management of
diabetes
 National diabetes educators manual
 Diabetes comprehensive care manual
 Diabetes prevention and management: A guide
for community health workers
 Kenya Diabetes Study group (KDSG)- Diabetes
Manual
Diabetes Projects
 MoMS and MoPHS in conjunction with DMI
(NGO) with funding from WDF
-diabetes education and awareness project (2005-2008)
-diabetes comprehensive care project-DCC (2009-2013)
-mobile foot clinic project-MFC (2009-2012)
-changing diabetes in children-CDIC (2010-2015)
 National diabetes registers
 National insulin registers
 Rockefeller foundation- DMI - diabetes awareness
and screening project
 Others projects by CDC, APHRC, Diabetes Kenya.
Diabetes programs
 Diabetes medical camps –by Safaricom-DMI, Diabetes Kenya,
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Pharmaceuticals companies , hospitals
Diabetes children's camps-Safaricom, Johnson and Johnson
Diabetes training-Diabetes Kenya, Handicap international
Patient support groups
Diabetes educators programs
Nutrition-diabetes programs
Diabetes education through audio, radio and print
SMS web portal diabetes support programs-Tuzungumzie
kisukari (DMI-WDF) English - SMS “subscribe” to - 0710 840
337, Swahili “jisajili” to - 0710 840 337
What are we doing in KNH?
 The diabetes fraternity has invested a lot in
setting up structures for the national diabetes
care centers country wide
 Over 70 diabetes comprehensive care centers
(provincial, district and sub district hospitals
 UoN and KNH diabetologists have improved the
curriculum in diabetes medical training
 Diabetes education training programs, diabetic
foot training, diabetes awareness and screening-
world diabetes day (14th November)
 Diabetes and Endocrinology center
Thank You

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